Fibroids

Question 1

Fibroids medical Mx

Answer 1

Conservative if asymptomatic
Treatments for HMB
Injectable GnRH agonist
Ulipristil acetate

Question 2

Treatments for HMB

Answer 2

LNG-IUS (1st line)
Tranexamic acid
Mefenamic acid
COCP

Question 3

Which fibroid unaffected by HMB treatments?

Answer 3

Submucal fibroid or enlarged uterus palpable abdominally

Question 4

Injectable GnRH agonists ib fibroids?

Answer 4

Only widely proven effective medical Rx
Induces menopausal state shuts down ovarian oestradiol
poorly tolerated

Question 5

Ulirpristil acetate in fibroids

Answer 5

SPRM
reduces size and HMB Sx
Not yet widely used
Does NOT induce menopausal state

Question 6

Medical Mx of fibroids, is it possible?

Answer 6

Not long term

Fibroids regrow when ovarian function returns

Question 7

Surgical Mx of fibroids

Answer 7

Depends on Sx

1. Minimally invasive hysteroscopic
2. Myomectomy
3. Surgical removal w/uterine conservation
4. Hysterectomy

Question 8

Suitable fibroids for minimally invasive hysteroscopic sugery

Answer 8

Submucosal

Fibroid polyp

Question 9

Which surgical procedures are indicated in bulky Fibroid uterus w/pressure Sx ?
(Or refractory to medical Rx)

Answer 9

1. (laparoscopic)Myomectomy:
   - preservation of fertility
   - small but sig. risk of uncontrolled bleed -> hysterectomy
2. Surgical removal of fibroids w/uterine convervation
3. Hysterectomy

Question 10

Which procedures for fibroid removal may be preceded with GnRH agonist? Why?

Answer 10

Hysterectomy and myomectomy
3mo
reduce bulk and vascularity of fibroid (allows suprapubic vaginal incision rather than midline TAH)
Quicker recovery, fewer Cx

Question 11

Radiological Treatmeant of Fibroids?

Answer 11

Uterine Artery Embolisation

Question 12

Uterine Artery embolisation procedure

Answer 12

Embolise both UAs under radio guidance
Cannula: femoral -> UA
Embolisation induces infarction and degeneration

Question 13

% of Uterine artery embolisation procedures that reduce fibroid volume?

Answer 13

50%

Question 14

Aftercare in Uterine artery embolisation

Answer 14

Often req. admission for pain, give opiate analgesia

Question 15

Complications of uterine artery embolisation

Answer 15

Fever
Infection
Fibroid expulsion
Potential ovarian failure
Treatment failure (1/3 req. some treatment within 5y)

Question 16

Counselling on fertility in uterine artery embolisation?

Answer 16

Effects uncertain

Question 17

Uterine artery embolisation effectiveness?

Answer 17

As effective as myomectomy for alleviating fibroid related HMB and pressure Sx

Question 18

Fibroids Summary

Answer 18

1st line symptomatic: LNG-IUS
Alternatives: TXA, COCP
GnRH red. size (usually pre surg)
Surgery: myomectomy, hysteroscopic ablation, hysterectomy
IR: UAE

Question 19

Adenomyosis

Answer 19

Endometrium breaks into myometrium

Question 20

Adenomyosis Ix

Answer 20

Ex: bulky, sometimes tender boggy uterus
USS: haemorrhage filled distended endometrial glands, may show irregular nodules (similar to fibroid)
MRI (BEST Investigation) - best images

Question 21

Adenomyosis Mx

Answer 21

Any treatment that induces amenorrhoea
LARCs (but Sx return on stopping)
Hysterectomy only definitive mx